Testing the effectiveness of an online CBT intervention with the S-ONapp method for both partners to reduce postpartum female sexual disorders

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Testing the effectiveness of an online CBT intervention with the S-ONapp method for both partners including sexuality, women who have gone through abuse sexual). A special category is regarding the sexual problems that occur in the postpartum period. Pregnancy and postpartum periods are marked by a series of major changes for women, changes that occur at multiple levels: physiological, psychological (cognitive, emotional), behavioral, socio-cultural (Soma-Pillay et al., 2016). From a physiological point of view, during pregnancy most body systems (endocrinological, neurological, cardiovascular, muscular, renal, digestive, respiratory, bone) undergo major changes, and those at the hormonal and neurological level have an impact especially on emotional and cognitive functioning of the mother. Emotionally, both pregnancy and the postpartum period are marked by anxiety, stress, ambivalent mood swings, fatigue, irritability, insomnia, changes in body image. In terms of behavioral and socio-cultural changes, the woman has to take on new roles and responsibilities, the usual old concerns are replaced by child-centered behaviors, which have an impact on the couple’s relationship and social life. This context of profound change and restructuring of the life to which the woman must adapt, inevitably influences sexual health, many women facing various types of sexual dysfunction in the postpartum period (Delgado-Pérez et al., 2022). Postpartum sexual problems include: loss or decrease in sexual desire, decreased frequency of sexual activity, difficulty achieving orgasm, decreased genital sensitivity and arousal, pain during intercourse, bleeding or irritation after intercourse (Gutzeit et al., 2020). Diagnostic criteria According to the American Psychiatric Association’s (2013) Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM- 5), female sexual dysfunctions are classified in: sexual desire or arousal disorder, orgasm disorder, genito-pelvic pain / penetration disorder. The diagnostic criteria according to DSM-5 will be presented below. Criteria for diagnosing sexual desire or arousal disorder in women involve a lack or significant reduction in sexual desire / arousal, manifested by at least three of the following symptoms: 1) reduced or no interest in sexual activity; 2) reduction or absence of sexual or erotic thoughts and fantasies; 3) lack or reduction of sexual initiative or lack of receptivity to partner initiatives; 4) reduction or absence of sexual arousal or pleasure during sexual intercourse in approximately 75% -100% of cases, 5) reduction or absence of sexual desire or arousal in response to any internal sexual or erotic stimulus; 6) reduction or absence of genital sensations or erogenous zones during sexual intercourse in approximately 75% -100% of cases (Diagnostic and Statistical Manual of Mental Disorders 5th ed .; DSM-5; American Psychiatric Association, 2013). The criteria for diagnosing orgasm disorder in women involve the presence of any of the following symptoms in all or almost all sexual acts: 1) marked delay of orgasm, very low frequency of orgasm or absence of orgasm; 2) very low intensity of orgasmic sensations (Diagnostic and Statistical Manual of Mental Disorders 5th ed .; DSM-5; American Psychiatric Association, 2013). Criteria for diagnosing genito-pelvic pain / penetration disorder involve persistent or recurrent discomfort associated with one of the following: 1) vaginal penetration during intercourse; 2) intense vulvovaginal or pelvic pain during intercourse; 3) intense fear or anxiety related to the appearance of vulvo-vaginal or pelvic pain; 4) marked tension or contraction of the pelvic floor muscles during the attempt at vaginal penetration (Diagnostic and Statistical Manual of Mental Disorders 5th ed.; DSM-5; American Psychiatric Association, 2013). For all the disorders mentioned, the following criteria are included in the diagnosis: the symptoms persist for a minimum of 6 months, cause significant clinical discomfort and are not better explained by any other mental disorder without a sexual component or by a consequence of a serious problem in the relationship or stressors and can not be attributed to the effects of substances, drugs 75
DELCEA and LERA (DEBUCEAN) or other medical conditions. (Diagnostic and Statistical Manual of Mental Disorders 5th ed.; DSM-5; American Psychiatric Association, 2013) Prevalence From a medical point of view, after birth, a woman’s sexual organs need about 6 weeks to return to the state before birth, but only 32% resume sexual activity between 6 and 8 weeks postpartum. Although most women resume their sexual life between 3 and 6 months postpartum (Matthies et al., 2019), however, only after 6 months postpartum, the frequency and sexual functioning are close to the situation before birth. Thus, many women report at least one sexual problem (Delgado-Pérez et al., 2022). The prevalence of sexual dysfunction is high in the postpartum period: 83% at 3 months postpartum, decreasing to 64% at 6 months postpartum, but below the antenatal value of 38% (Barrett et al., 2000) To identify the prevalence of postpartum sexual dysfunction, many studies investigate physical issues such as: dyspareunia, decreased or missing vaginal lubrication, pain during or during intercourse, changes in the vagina, bleeding during intercourse, loss of sexual interest, difficulties in having an orgasm (Barrett et al., 2000; Gutzeit et al., 2020). Most studies of postpartum female sexual disorders focus on the resumption of sexual life, perineal pain and dyspareunia, and self-reported sexual problems. O’Malley et al. (2021) argues the need for a more holistic approach to the sexual problems faced by women in the postpartum period, including the emotional and social factors involved. Applying such an approach in research would bring new information about the prevalence of postpartum sexual problems. Risk factors A more complex approach to the factors that influence postpartum sexual dysfunction takes into account several dimensions: physical, social, psychological, relational (O’Malley et al., 2021). Among the physical factors that influence female sexuality in the postpartum period were studied: type of birth, normal or instrumentally assisted vaginal or cesarean delivery, perineal trauma, dyspareunia, breastfeeding (Abdool et al., 2009; Gutzeit et al., 2020). Emotional factors that play a role in the etiology of postpartum sexual problems are: postpartum depression, anxiety, distorted self-image (Delgado-Pérez et al., 2022; O’Malley et al., 2021). Social and relational factors include: responsibility and adaptation to the new role, social and practical support (O’Malley et al., 2021). Also involved are factors such as extreme fatigue, lifestyle changes, emotional connection with the child, a new vision of the concept of sexuality oriented towards emotional intimacy (Delgado-Pérez et al., 2022; O’Malley et al., 2021). Abdool et al. (2009) reviews postpartum sexual disorders and associated risk factors. Genito-pelvic pain disorder is the most common in the postpartum period due to birth with perineal trauma, episiotomy, instrumental. In the first 3 months postpartum, dyspareunia was associated with vaginal birth and its presence before birth. At 6 months postpartum, however, dyspareunia was associated with breastfeeding and antenatal dyspareunia. Regarding sexual desire or arousal disorder, studies have shown a decrease in frequency and sexual desire in the postpartum period. Sexual interest improves over time, but other factors that change in the postpartum period are important: the mother’s body image and mental health, marital relationship. Sexual arousal is influenced by fatigue, depression, distractions, sexual anxiety and negative expectations caused by dyspareunia. Orgasmic disorder is also affected by perinatal trauma at birth. Compared to the year before birth, more women reported pain at orgasm or difficulty reaching orgasm at 3 and 6 months postpartum. Regarding the influence of postpartum depression, studies show that compared to women who do not suffer from depression, for those with postpartum depressive symptoms, they are less likely to resume sexual activity 6 months after birth and report sexual problems. (Abdool et al., 2009). 76
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Testing the effectiveness of an online CBT intervention with the S-ONapp method for both partners to reduce postpartum female sexual disorders

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